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Inspection visit

Routine inspection

MONTEVERDE MANOR IIILicense 4156007544 citations on this visit
4 citations recorded

Inspector’s narrative

What the inspector wrote

On 05/06/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with caregiver KimIvanWilfred Budy and explained the purpose of today's visit. Currently there are 6 residents present and 2 caregivers. The facility is licensed for age range 60 years and over. All are approved to be non-ambulatory. Hospice waiver for 3 residents. Currently there are no residents on hospice per staff interviewed. The facility ambient temperature is comfortable. There are Required postings are in place observed in main dining area. Water temperature is tested in the common hallway full bathroom measuring as 135F near room 6. Additional bathroom water temperature is measured at 135F in another full bathroom near room 4. Cleaning supplies are observed to be locked in the garage primarily. Facility knives are observed to be locked in the kitchen in a drawer adjacent to the cooking range and stove. Facility food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. The garage has additional refrigerators with staff and resident food and additional emergency food supplies. Laundry area is observed in the garage as well and is fully operational. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. There is a locked storage shed in the backyard that contains garden supplies and furniture. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed 3 fire extinguishers are observed in the facility. Both with inspection dates of 10/04/2024. Both are charged and ready for use. Facility conducts emergency drill quarterly. The last drill that was conducted is logged 04/30/2025. Linens are in place for resident in care. Continued on next page... Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Medications are current, locked, and logged appropriately. First aid kit is present. There are two bathrooms, one is used as the main shower for residents, with grab bars and non-skid mats. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA reviewed 4 resident files and 4 staff files on this day. LPA observed that residents 1 through 4 do not have doctor orders for half bed rails or full bed rails. Staff training records are observed to be current and in place. Administrator certificate for Dino Martin is observed as current expiring 12/18/2024. LPA informed facility that annuals fees are overdue as of today's visit. The following updated items are to be received by 05/13/2025 : • Copy of updated administrator certificate • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC402 Surety bond and Copy of active bond • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or copy of lease Report is reviewed with KimIvanWilfred Budy . A copy of this report is provided to the facility. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Technical advisory issued on attached LIC9102 Civil penalty is assessed due to a repeat violation which equals to $250. See attached LIC421FC(7/17)

Citations

4 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87608(a)(5)Type A

    Prohibit tying or restricting resident hands or feet

    POSTURAL SUPPORTS 87608(a)(5) - Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This regulation has not been met as evidenced by: Based on observations made, residents number R1, R2, and R4 have full bed rails. Licensee failed to prohibit use of full bed rails, which poses an immediate health, safety or personal rights risk to clients in care.

  • 87303(e)(2)Type A

    Provide resident hot water for personal care

    (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This regulation has not been met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 2 out of 2 bathroom faucets which delivered hot water at 135 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.

  • 87458(a)Type B

    Obtain baseline medical assessment before resident admission

    87458(a) Medical Assessment - (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This regulation has not been met as evidenced by: Based on resident files reviewed, R3 does not have a physicians report on file.This poses a potential health and safety risk for residents in care.

  • 87608(a)(3)Type B

    Maintain physician order documentation in resident record

    POSTURAL SUPPORTS 87608(a)(3) - A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record.This requirement has not met as evidenced by: Based on observations made, R3 is observed to have hafl bed rails in place but there is no order on file for the resident to have the bed rails in place. Those poses a potential health and safety risk.

FAQ · About this visit

Common questions about this visit

What happened during the May 6, 2025 inspection of MONTEVERDE MANOR III?

This was an inspection of MONTEVERDE MANOR III on May 6, 2025. 4 citations were issued: 2 Type A (serious) and 2 Type B.

Were any citations issued to MONTEVERDE MANOR III on May 6, 2025?

Yes, 4 citations were issued (2 Type A, 2 Type B). The first citation was for: "POSTURAL SUPPORTS 87608(a)(5) - Bed rails that extend the entire length of the bed are prohibited except for residents w..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.